Poster Presentation The Annual Scientific Meeting of the Australian Diabetes Society and the Australian Diabetes Educators Association 2013

Poor adherence to treatment guidelines of diabetic ketoacidosis leads to increased incidence of hypokalemia (#338)

Chris Gilfillan 1 , Geetha Theverkalam 2
  1. Endocrinology, Eastern Health, Melbourne, Vic, Australia
  2. Austin/Northern Hospital, Box Hill South, Vic, Australia

Diabetic Ketoacidosis is the most common hyperglycemic emergencies presenting to hospitals2. And it has been shown that standardised guidelines of therapy improve treatment outcomes and lower mortality and morbidity5. Hypokalemia is a common complication associated with DKA treatment. Our Institution has standardised guidelines for management of all hyperglycemic emergencies including fluid resuscitation,insulin infusion and potassium replacements.
To assess the prevalence of hypokalemia on admission in hyperglycemic emergencies and to evaluate the incidence of hypokalemia as a complication related to treatment
A retrospective audit was undertaken to study the implementation of potassium replacement guidelines in the management of Diabetic ketoacidosis in a tertiary centre, which comprised of three hospitals. Data on all hyperglycaemic emergencies presenting to this institution from Jan –Dec 2012 was collected and evaluated for implementation of treatment guidelines and the development of hypokalemia
One hundred and sixteen patients were evaluated with hyperglycemic emergencies all requiring insulin dextrose infusion.109 were DKA (93.1%). Hypokalemia (<3.5mmols/L) on admission was noted in 6 patients (5.17%) in keeping with previously published data1. Despite this 66/109(60%) patients did not receive potassium replacements as per protocol and the rate of development of hypokalemia during treatment was 69%.
Diabetic ketoacidosis patients have total body depletion of potassium and insulin therapy can worsen the situation with shifts to the intracellular compartments2,4. We have demonstrated that poor adherence to treatment guidelines does lead to high incidence of hypokalemia during treatment of diabetic ketoacidosis. Hypokalemia can be potentially fatal and the need to manage it proactively rather than reactively needs to be emphasised in the acute care settings2,3.